Honolulu, Hawaii

Defensive Medicine Health Care Case Study

Does your doctor perform a lot of unnecessary tests when you go for a visit? Not mine. The typical situation is when I ask about getting tested for something that I saw on TV or read about and my doctor telling me that he doubts that my health insurer will pay for it. So I don’t get the test despite the fact that I had information saying that people should be checked out for the condition. Sound familiar? I’ll bet it does.

Let’s look at a real case: Gustavo Espinal-Santos.

Gustavo died on January 1, 2004, after contracting blastomycosis, a fungal infection often transmitted through water or soil.

Gustavo went to the doctor at the Bellin Family Medical Center in Bonduel, Wisconsin in December 2003 complaining of illness and was seen by "physician assistants" (PA’s) who concluded that Gustavo had pneumonia. The PA’s failed to take x-rays or other basic tests that would have shown that the condition wasn’t pneumonia and that Gusatvo actually had blastomycosis. It sure doesn’t look like the folks at Bellin family Medical Center are wasting a lot of money and time – and driving up our health care costs – by practicing defensive medicine. Am I missing something?

And while we are looking at the poor harassed medical profession, can someone explain to me how tort reform would have saved Gustavo Espinal-Santos. I am sure that the insurance industry and the doctors who want to take away the rights of folks like Gustavo, after taking his life by not doing standard medical tests, can explain how eliminating patients’ rights would have saved Gustavo. And of course if we can stop Gustavo’s family from suing this health care provider I am sure that others like him will be saved in the future.

Richard Ryman of the Green Bay Press Gazette reported on October 2, 2009 that a jury decided that the PA’s at Bellin should have done more tests and found them guilty of being negligent. Should we feel sorry for the PAs or for Bellin? Is this case an outrage? Is it lawsuit abuse? Jackpot justice? What do you think? Here are the facts as reported by Richard Ryman.

Espinal-Santos wen to Bellin twice. He was admitted to St. Vincent Hospital on Dec. 23, 2003, and diagnosed with blastomycosis, but it was too late to save his life. The jury decided that

Bellin Health System and Dr. Peri Aldrich, who was responsible for overseeing the physician assistants, were negligent.

The jury verdict of $3.7 million will be reduced because of caps on damages in cases against doctors in Wisconsin. That means that Gustavo Espinal-Santos’ survivors including his wife, Maria Zavala McDaniel, and daughters Maria Espinal-Zavala, 10, and Anna Sophia Espinal, 5 will not receive what they are entitled to and the medical malpractice insurance company will have more money in their bank account. Is that what really matters: keeping the money in the bank accounts of insurance companies and going easy on sloppy medical practices that take away Maria’s and Anna’s father forever?

The good folks at Bellin Health issued a statement Friday on the verdict.

"Foremost, Bellin Health wishes to express our empathy to the Santos family. It is difficult any time you lose a family member. Bellin Health is obviously disappointed with the verdict and believes the care provided was appropriate and followed established medical protocols. We are now determining what, if any, other action will be taken in this matter. Out of respect for the privacy of the family, we will have no further public comment.”

The Wisconsin legislature deiced to take care of doctors who kill people with avoidable medical errors rather than the family of Gustavo Espinal-Santos.

Defensive medicine? What we need is for patients to be more defensive to protect themselves from doctors who don’t do enough – or the right – tests. Because once you are dead their will not be an adequate remedy in the courts in Wisconsin. They want to do this in Hawaii. I hope our legislators know better than to fall for caps on damages in medical malpractice cases.

Does anyone out there actually think that doctors are practicing defensive medicine and ordering too many tests? Remember that the private health insurers won’t even pay for necessary tests. This whole issue is another myth from the insurance industry. What we need is to remove the anti-trust exemption from insurance companies. Stay tuned because I am going to write on that subject next.

1 Comment

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Wayne: Thanks for calling this issue to the attention of the public. My attitude is that you are correct, “unnecessary tests” will be refused by insurance companies and doctors will not perform them. However, assuming that an “unnecessary” test is administered, I would prefer the unnecessary test to failing to perform one that would diagnose a serious condition. The whole “unnecessary test” argument is baloney, as you have correctly pointed out.

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